Impact of socioeconomic deprivation on mechanical thrombectomy outcomes after acute ischemic stroke: findings from a London-Based Multicentre Study
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Author(s)
Type
Journal Article
Abstract
Background Mechanical thrombectomy (MT) improves
outcomes in patients who had an acute ischaemic
stroke due to large vessel occlusion (LVO). However,
socioeconomic status (SES) can influence recovery and
prognosis. This study investigated the effect of SES,
assessed via the Index of Multiple Deprivation (IMD), on MT
outcomes in a multicentre London cohort.
Methods This retrospective study included patients with
anterior circulation LVO treated with MT between 2021 and
2023 at three London hospitals. Patients were grouped into IMD1–5 (more deprived) and IMD6–10 (less deprived). Inverse probability weighting balanced baseline characteristics. Primary outcomes were 90- day functional independence (modified Rankin Scale (mRS) 0–2) and 90- day mRS shift. Secondary outcomes included recanalisation, early neurological changes, 90- day mortality, symptomatic intracerebral haemorrhage (sICH) and haemorrhagic transformation (HT). Subgroup analyses explored interactions between IMD and demographic or clinical factors. LASSO (Least Absolute Shrinkage and Selection Operator) regression identified predictors of functional independence, while receiver operating characteristic analysis evaluated IMD’s predictive value.
Results Among 1219 patients with acute LVO ischemic
stroke treated with MT, 533 (43.7%) were in IMD1–5
and 686 (56.3%) in IMD6–10. IMD1–5 patients had lower odds of functional independence at 90 days (RR 0.79, 95% CI 0.70 to 0.90) and worse mRS shift (OR 1.29, 95% CI 1.06
to 1.58). They also had higher risks of sICH (RR 2.07, 95%
CI 1.54 to 2.67) and HT (Risk Ratio 1.47, 95% CI 1.21
to 1.80). Subgroup analysis highlighted IMD’s predictive
importance in Asian or mixed ethnicity groups. A model
incorporating IMD, age, sex, hypertension and National
Institutes of Health Stroke Scale (area under the curve
0.656) demonstrated predictive accuracy for 90- day
functional independence. Conclusions Lower SES correlates with worse outcomes and higher complications post- MT, even within a universal healthcare system. Addressing SES disparities could improve stroke care equity.
outcomes in patients who had an acute ischaemic
stroke due to large vessel occlusion (LVO). However,
socioeconomic status (SES) can influence recovery and
prognosis. This study investigated the effect of SES,
assessed via the Index of Multiple Deprivation (IMD), on MT
outcomes in a multicentre London cohort.
Methods This retrospective study included patients with
anterior circulation LVO treated with MT between 2021 and
2023 at three London hospitals. Patients were grouped into IMD1–5 (more deprived) and IMD6–10 (less deprived). Inverse probability weighting balanced baseline characteristics. Primary outcomes were 90- day functional independence (modified Rankin Scale (mRS) 0–2) and 90- day mRS shift. Secondary outcomes included recanalisation, early neurological changes, 90- day mortality, symptomatic intracerebral haemorrhage (sICH) and haemorrhagic transformation (HT). Subgroup analyses explored interactions between IMD and demographic or clinical factors. LASSO (Least Absolute Shrinkage and Selection Operator) regression identified predictors of functional independence, while receiver operating characteristic analysis evaluated IMD’s predictive value.
Results Among 1219 patients with acute LVO ischemic
stroke treated with MT, 533 (43.7%) were in IMD1–5
and 686 (56.3%) in IMD6–10. IMD1–5 patients had lower odds of functional independence at 90 days (RR 0.79, 95% CI 0.70 to 0.90) and worse mRS shift (OR 1.29, 95% CI 1.06
to 1.58). They also had higher risks of sICH (RR 2.07, 95%
CI 1.54 to 2.67) and HT (Risk Ratio 1.47, 95% CI 1.21
to 1.80). Subgroup analysis highlighted IMD’s predictive
importance in Asian or mixed ethnicity groups. A model
incorporating IMD, age, sex, hypertension and National
Institutes of Health Stroke Scale (area under the curve
0.656) demonstrated predictive accuracy for 90- day
functional independence. Conclusions Lower SES correlates with worse outcomes and higher complications post- MT, even within a universal healthcare system. Addressing SES disparities could improve stroke care equity.
Date Issued
2025-04-23
Date Acceptance
2026-10-28
Citation
European Stroke Journal, 2025, 10 (6)
ISSN
2396-9873
Publisher
Oxford University Press
Journal / Book Title
European Stroke Journal
Volume
10
Issue
6
Copyright Statement
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.
License URL
Identifier
10.1136/svn-2024-003915
Publication Status
Published
Article Number
003195
Date Publish Online
2026-04-09